Stereotactic fine needle aspiration biopsy (FNAB) is being offered at many centers across the United States in lieu of open surgical biopsy for nonpalpable mammographic lesions. To determine how accurate this procedure is in a community hospital, the authors performed stereotactic FNAB of 62 nonpalpable mammographic lesions using Siemens upright stereotactic equipment. FNAB was immediately followed by hook wire localization and open biopsy. Ten lesions were histologically malignant. Seven of these had been identified cytologically as atypical, suspicious or malignant. Three carcinomas were undetected by FNAB, for a sensitivity rate of 70 percent. There were no false-positive FNAB diagnoses. Three different radiologists performed the FNAB and localizations. Our results were insufficiently sensitive to be able to offer stereotactic FNAB to patients in lieu of open surgical biopsy. We are currently planning to evaluate the dedicated stereotactic prone biopsy equipment to compare the results of needle core biopsies with subsequent hook wire localization and open biopsy.